Provider Demographics
NPI:1073024386
Name:CIRCLE OF CARE AND HOPE MENTAL HEALTH HEALING AND EMPOWERMENT CENTER,
Entity Type:Organization
Organization Name:CIRCLE OF CARE AND HOPE MENTAL HEALTH HEALING AND EMPOWERMENT CENTER,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & FOUNDER, CCH
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:EDVALINE
Authorized Official - Last Name:VANSIEA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,MA,MS,RNAPRN
Authorized Official - Phone:651-460-0193
Mailing Address - Street 1:626 RXR PLZ FL 6
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-0626
Mailing Address - Country:US
Mailing Address - Phone:516-247-3535
Mailing Address - Fax:
Practice Address - Street 1:626 RXR PLZ FL 6
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11556-0626
Practice Address - Country:US
Practice Address - Phone:516-253-6922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4951221163W00000X, 163W00000X
NYF4018161363LP0808X, 363LP0808X
GARN267072163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty